Mujugira Andrew, Nakyanzi Agnes, Bagaya Monica, Mugisha Jackson, Kamusiime Brenda, Nalumansi Alisaati, Kasiita Vicent, Ssebuliba Timothy, Nampewo Olivia, Nsubuga Rogers, Muwonge Timothy R, Bukenya Musa, Gandhi Monica, Wyatt Monique A, Ware Norma C, Haberer Jessica E
Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala, Uganda.
Department of Global Health, University of Washington, Seattle, WA, USA.
AIDS Behav. 2025 Jan;29(1):133-142. doi: 10.1007/s10461-024-04469-x. Epub 2024 Sep 2.
Tenofovir alafenamide fumarate (F/TAF) pre-exposure prophylaxis (PrEP) is understudied in sub-Saharan Africa. The Tandika PrEP study was a randomized trial that evaluated same-day F/TAF initiation, the impact of drug-level feedback on PrEP adherence, and integrated PrEP and sexually transmitted infection (STI) services for HIV-negative transgender women (TGW) in Uganda (NCT04491422). From April 2022-February 2023, a qualitative sub-study of 30 in-depth interviews explored (1) perspectives on same-day initiation of F/TAF PrEP, (2) experiences of urine tenofovir testing and drug-level feedback, and (3) descriptions of self-collection of samples for STI testing. Qualitative data were analyzed using an inductive content analytic approach. Integrated PrEP/STI services were valued by TGW because the convenience of urine testing motivated adherence and allowed for tenofovir and STI detection. (1) Preferred characteristics: F/TAF-based PrEP was easy to take and not readily identifiable as an HIV-related medication, resulting in less stigma than the better-known tenofovir disoproxil fumarate (F/TDF). Weight gain associated with F/TAF use was viewed positively by TGW as a symbol of health and prosperity in African settings. (2) Adherence motivation: PrEP adherence was motivated by a desire not to disappoint healthcare workers; TGW reciprocated adherence support and drug-level feedback by taking PrEP. (3) Facilitating adherence and STI care: Urine testing enhanced STI detection and treatment. Utilization of urine for tenofovir and STI testing motivated the uptake of HIV/STI care, emphasizing the importance of integrated PrEP and STI services. Integrating PrEP/STI services into differentiated delivery models could increase prevention uptake in this vulnerable population.
替诺福韦艾拉酚胺富马酸盐（F/TAF）暴露前预防（PrEP）在撒哈拉以南非洲地区的研究较少。坦迪卡PrEP研究是一项随机试验，评估了当日启动F/TAF、药物水平反馈对PrEP依从性的影响，以及为乌干达的HIV阴性跨性别女性（TGW）整合PrEP和性传播感染（STI）服务（NCT04491422）。从2022年4月至2023年2月，一项包含30次深入访谈的定性子研究探讨了：（1）对当日启动F/TAF PrEP的看法；（2）尿液替诺福韦检测和药物水平反馈的经历；（3）自我采集样本进行STI检测的描述。定性数据采用归纳性内容分析方法进行分析。TGW重视整合的PrEP/STI服务，因为尿液检测的便利性促进了依从性，并能检测替诺福韦和STI。（1）首选特征：基于F/TAF的PrEP易于服用，且不容易被识别为与HIV相关的药物，与更知名的替诺福韦酯富马酸盐（F/TDF）相比，耻辱感更小。在非洲环境中，TGW将与使用F/TAF相关联的体重增加视为健康和繁荣的象征。（2）依从性动机：PrEP依从性的动机是不想让医护人员失望；TGW通过服用PrEP来回应依从性支持和药物水平反馈。（3）促进依从性和STI护理：尿液检测增强了STI的检测和治疗。利用尿液进行替诺福韦和STI检测促进了HIV/STI护理的接受，强调了整合PrEP和STI服务的重要性。将PrEP/STI服务整合到差异化的服务模式中，可以增加这一弱势群体对预防措施的接受度。
